Mental Health and Other Factors Associated with COVID-19 Vaccination Intention toward Children of Military Parents in Lambayeque, Peru

There is evidence that vaccine acceptability is strongly associated with mental health. However, no studies assessing intention to vaccinate (ITV) intention toward children of military parents have been documented. The current research aimed to establish the prevalence and factors of ITV children against COVID-19 in military parents in Lambayeque-Peru, 2021. Analysis was conducted with the dependent variable ITV children reported by military parents. The independent variables were history of mental health, searching for mental health support, food insecurity, resilience, anxiety, depression, burnout, posttraumatic stress, and suicidal risk. Prevalence ratios and 95% confidence intervals were estimated. Of 201 military personnel evaluated, 92.5% were male, 82.5% were of the Catholic faith, and the median age was 40.9% of respondents reported seeking mental health help during the COVID-19 pandemic. It was reported anxiety (20.3%), depression (6.5%), and posttraumatic stress disorder (6.5%). Most reported ITV in children against COVID-19 (93%). In the multiple models, we found that Catholics had a 23% higher prevalence of ITV in the children where PR = prevalence ratios and CI = confidence intervals (PR = 1.23; 95% CI: 1.01–1.50). Likewise, seeking mental health support increased the prevalence of ITV by 8% (PR = 1.08; 95% CI: 1.00–1.15). Seeking mental health support and belonging to the Catholic faith had a higher ITV of children of Peruvian military personnel. Finding mental health support, experiencing burnout syndrome, having a relative who suffers from mental health problems, and being part of the Catholic religion were associated with a higher willingness to immunize the children of Peruvian military members.


Introduction
Since the sustainable development goals (SDGs) were established, various eforts have been developed globally to contribute to achieving the specifc goals.In the feld of health, specifcally, there are reports of initiatives to contribute to SDG 3 focused on health, such as digital health [1,2], health policies [3][4][5][6], and COVID-19 [7].Because of the pandemic, many of the eforts may have served as previous experience to have a better response capacity, which is the case for countries with an excellent vaccination system [8][9][10][11].Eforts to ensure sustainability during the pandemic are contained in Target 3.3: "By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, waterborne diseases, and other communicable diseases."On the other hand, target 3.4 is also currently an aspect that has been negatively impacted by COVID-19: mental health, which needs specifc programs to treat people after the tremendous impact on their lives due to having witnessed diaries of deaths of friends and family, job losses, and impoverishment.Finally, the 3.8 targets are still pending since health coverage was the key to whether a person could live or die during the most challenging pandemic.After this pandemic, it is necessary to evaluate the remaining gaps to shorten them and provide the population with health coverage in general.
Te implementation of social distancing [12,13] and quarantines [14,15] because of the COVID-19 pandemic [16] generated various mental health efects [17,18].Peru was severely damaged because both waves generated the country's highest mortality rate [19], which afected the population [20].Te population was exposed to fake news [21] and conspiracy theories [22], which generated technostress [23] and multitasking behavior [24].Te lack of adequate policies causes mental distress [25] and urgency for self-care behaviors [26], including the use of unproven drugs [27] and medicinal plants [28].Previous research assessed the impact of social distancing measures during the early months of the COVID-19 pandemic in the United States and revealed that stay-at-home orders and social distancing policies signifcantly reduced infection and death rates.Notably, efectiveness varied across states, correlating with income, education, demographics, political afliations, and media consumption.Tis information is crucial for contextualizing our study on military parents' mental health and vaccination intentions.Te efectiveness of social distancing measures provides insights into potential variations in policy impact based on socioeconomic and demographic factors.In our study, akin to the challenges faced by Peru, we acknowledge the broader consequences of such policies on mental health, including exposure to misinformation and subsequent technostress.
A worldwide mass immunization campaign has been imperative to reduce cases and mortality [29].Today, approximately 55.9% of the world's population has been immunized with at least two doses of the COVID-19 vaccine.In Peru, 70.5% of the population is vaccinated against COVID-19 [30].Peru is the sixth-ranked country with the highest percentage of vaccination in Latin America [31].However, to achieve success in ending the pandemic, a strategic vaccination scheme with broad coverage continues to be carried out judiciously and rapidly, evaluating the facilitating or limiting factors in the target population remaining to be immunized [32].Worldwide, the vaccine acceptance rate against COVID-19 is 60%.In Europe, Denmark has the highest acceptance rate (80%) for vaccination; in Ecuador, the highest rate in Latin America was 97% [33].In China, it was determined that 91.3% of the participants intended to vaccinate (ITV), and the infuencing factors were gender, marital status, and risk perception [34].On the other hand, in Peru, the national reality regarding vaccination intention is often regionally contrasted; the highest ITV is found in Lima province (81.4%), while the lowest rate was found in Madre de Dios (53.9%) and Ucayali (69.9%) [35].Additionally, living in a rural area and the female gender were the main factors limiting the ITV, while the unstable economy, having clinical COVID-19, or being seriously ill with COVID-19 were linked with a higher ITV [35].It is relevant to note that, according to the research by Bao and Huang [36], it was found that women are more responsive to social pressure, while men are more sensitive to fnancial incentives.Tese results, obtained in a diferent context, raise the possibility of gender diferences in vaccine acceptability and intention to vaccinate, which could infuence our fndings in the study of military parents.Tus, considering these gender dynamics identifed by Bao and Huang, it is essential to explore how such diferences might impact vaccination intentions among military parents, especially in an environment where gender has already been identifed as a critical factor in vaccination decision-making.
However, few studies on ITV children have been reported by parents.In a systematic review evaluating 44 studies and 317,055 parents from the USA, China, Saudi Arabia, India, European countries, and Oceanic countries, only 60.1% of these parents expressed a desired ITV for their children [37].However, no study has yet been conducted in Peru on the impact of mental health on the ITV against COVID-19 in military personnel.Tere is evidence that afrms a probable positive impact of mental health (depression and anxiety) on the acceptability of the vaccine.However, no reports have been published describing the ITV of their children in military parents [38,39].As military personnel and health personnel have been on the front lines of organization and care for COVID-19 since the pandemic's beginning to safeguard national security, this remains variable to understand.
A similar investigation afrms that adults have a higher probability of ITV against COVID-19.However, only fear of the risk of having this disease was measured [40], but the infuence of other psychological factors (anxiety, depression, posttraumatic stress, burnout syndrome, and mental health support), which could infuence acceptability, were previously not considered and are analyzed in our study.Additional research on South Korean parents reported that age, 2 Te Scientifc World Journal higher education, family economy, and the number of children in the family unit positively impact parents' willingness to vaccinate their children.However, whether parental gender has statistical signifcance was not determined [41].Likewise, other research excludes the male gender and has studied only maternal intentions [42].Although our study includes a small proportion of male soldiers, it enables us to evaluate whether this variable infuences the ITV of their children.Other studies in the United States have estimated parental vaccine acceptability at 44.2% and 61.9%.However, their fndings are descriptive, and the efect of variables infuencing ITV was not evaluated [43,44].In Peru, it was found that 75% of those surveyed had the ITV; however, the data were obtained through online questionnaires, which could lead to channeling and information bias.
Contrary to this research, in which personal interviews were conducted with an ofcial in charge of control, this study does not specify the acceptance intention, which may not be prudent for this specifc region of northern Peru where COVID-19 has been very adversely hit during the pandemic [35].Additionally, within our military parent study, this research allows us to delve into the potential infuence of government policies and interventions on vaccination intentions and mental health outcomes.Drawing on the insights from Li et al.'s investigation into the efectiveness of nonpharmaceutical policies such as lockdowns and subsidies, we can examine how these measures might shape the attitudes towards vaccination and mental well-being among military parents.Li et al.'s fndings, indicating that economic impacts are manageable and policies should be tailored to specifc socioeconomic groups, provide a foundation for understanding how targeted interventions can be tailored for distinct demographic segments within the military parent community.
Tis study is poised to delve into a crucial and underexplored facet of public health, the COVID-19 vaccination intentions of military parents for their children.Te signifcance of unraveling the intricacies within this demographic lies in safeguarding the health of military children and recognizing the unique challenges and stressors this population faces.Military families navigate distinct circumstances, including potential deployment-related stressors, frequent relocations, and the inherent demands of serving in the armed forces.In the global pandemic, understanding the vaccination intentions of military parents becomes paramount.
By explicitly addressing the factors associated with the COVID-19 vaccination intentions within this cohort, with a keen focus on mental health, we aim to shed light on the nuanced interplay between psychological well-being and vaccine decision-making.Tis study is not merely an exploration of statistical associations; instead, it is a strategic efort to bridge the gap between the mental health challenges experienced by military parents and their decisions regarding the health and well-being of their children.
Te importance of this research extends beyond the immediate scope of COVID-19, as insights gained can inform targeted interventions and policies tailored to the unique needs of military families.As frontline defenders, their health decisions bear broader implications for the overall readiness and resilience of the armed forces.Tus, unraveling the intricate web of mental health and associated factors infuencing vaccination intentions, we contribute valuable knowledge that can shape public health strategies and support systems for military families, fostering a comprehensive and tailored approach to vaccination eforts.
Terefore, the aim was to establish the prevalence and factors associated with ITV children against COVID-19 in military parents in Lambayeque, Peru, 2021.

Study Design.
It was an analytical cross-sectional study of secondary data analysis using the database of a primary study to evaluate factors linked with mental health illness in military personnel in the Lambayeque region in the second wave of the COVID-19 pandemic in November 2021 [45].Te specifc data collection from only one city can limit the generalization of the outcomes.Also, the lack of control of confounding variables could infuence vaccination intentions; therefore, this is a limitation that is recognized in the current study.

Space and Time.
Te preliminary study was conducted from November 02 to 09, 2021, during the second COVID-19 pandemic in the Lambayeque-Peru region.Lambayeque has been the tenth most aficted region in the COVID-19 pandemic [46], with 104,403 cases by February 20, 2022.

Sampling.
Te study population was military personnel in a health emergency area in November 2021 in the Lambayeque Peru Region.It used a nonprobabilistic convenience sampling.Te list of the VII Infantry Brigade (Lambayeque, Cajamarca, and Ancash) was requested.In the primary study, we estimated a population size of 820 military personnel.Expecting a prevalence of 12.8% based on relevant literature, we aimed for a robust statistical foundation with a 99% confdence level and a precision of 2.5%.Tis calculation resulted in an initial sample size requirement of 485 individuals.A prudent approach was adopted, incorporating a 10% rejection rate and a 10% allowance for incomplete registrations to account for potential rejection and incomplete registrations.Consequently, the adjusted required sample size for our study was 582 individuals.During the data collection phase, we successfully enrolled 710 military personnel who willingly participated in the study.Nevertheless, 95 military personnel were not included in the fnal analysis as their responses on the Patient Health Questionnaire 9 (PHQ-9) instrument (depression) and General Anxiety Disorder-7 (GAD-7) instrument (anxiety) were incomplete.Consequently, the fnal sample size for the primary study was 615 military personnel.From this secondary study, 201 individuals reported having children and were specifcally selected for inclusion in this analysis.

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We estimated statistical power considering covariates such as suicidal risk, personal mental history, and Catholic religion.For suicidal risk, a statistical power of 53.03% was obtained, utilizing vaccination intention proportions in parents without suicidal risk (p1 � 0.927) and with suicidal risk (p2 � 0.750), along with the group without suicidal risk (n1 � 124) and with suicidal risk (n2 � 12).Regarding the personal mental history factor, we employed vaccination intention proportions in parents without a mental history (p1 � 0.935) and with a mental history (p2 � 0.500), as well as the group without a mental history (n1 � 199) and with a mental history (n2 � 2), resulting in a statistical power of 60.36%.Finally, for the variable "Catholic," a statistical power of 82.68% was estimated, considering vaccination intention proportions in non-Catholics (p1 � 0.800) and Catholics (p2 � 0.958), along with the group of non-Catholic parents (n1 � 35) and Catholic parents (n2 � 166).Te sample size, the magnitude of the expected efect, the level of statistical signifcance, the variability of the data, and the validity of the assumptions made have been considered to ensure the power of the analysis.

Selection Criteria. All military personnel on duty for at least one month during the COVID-19 health emergency in
Lambayeque in 2021 were included in the study.All military personnel who had requested their temporary leave due to COVID-19 risk factors, performed remote work in home isolation after testing positive for COVID-19, and belonged to other regions of Peru were excluded from the study.Te criterion for elimination was the inadequate completion of the data collection form.

Variables and Instruments.
Te dependent variable was the ITV children reported by military parents.Te independent mental health variables were history of mental health, seeking mental health support, resilience, anxiety, depression, burnout, posttraumatic stress, and suicidal risk.Te instruments used are described as follows: (a) Abbreviated Connor-Davidson Scale (CD-RISC): Ten items that measure resilience globally through a Likert scale with a score of 0-4, whose relationship between the score and the presence of resilience is directly proportional and is classifed according to quartiles (low: frst quartile, middle: second and third quartiles, and high: fourth quartile) [47].It has been validated in older adults [48], health personnel [49], young adults [50], and Spanish-speaking fbromyalgia patients [51].(b) Generalized anxiety disorder 7-item scale (GAD-7): Seven questions and assesses the frequency of symptoms during the last 2 weeks [52].It was validated among a group of immigrants of Hispanic origin living in the USA [53].A cutof point of 10 or more represents the optimal compromise between sensitivity and specifcity (>80%) [52][53][54] and is associated with a positive predictive value of >99% and a negative predictive value of 0.833 [54].
(c) Patient Health Questionnaire-9 (PHQ-9): It is a selfadministered version measured according to a Likert scale consisting of nine criteria to evaluate signifcant depression [55] whose cutof point greater than and equal to 10 represents an optimal compromise between sensitivity and high specifcity [56] In the bivariate analysis, diferent tests were used to compare proportions and numerical variables.Students' ttests were used for numerical variables, while the chi-square test was used for proportions.For those variables without normal distribution, the Mann-Whitney U test.Te signifcance level used was 5%.Te simple and multiple regression analysis estimated factors associated with intention to vaccinate using the prevalence ratio (PR) and 95% confdence intervals (CI 95%).Also, it used generalized linear models (GLM) with Poisson distribution, log-link function, and robust variance.

Ethical Considerations and Dissemination.
Te confdentiality of each study participant was respected by using a code and avoiding using their names.Te data collected were handled solely and exclusively by the research team and in a data storage platform that did not include identifying variables of the study participants.Te Ethics Committee approved ofcio No's study.269-2021-CIEI-FMH-USMP from Universidad de San Martín de Porres.

Psychosocial and Occupational Characteristics of Military
Parents.Of the 201 military personnel evaluated, the majority were male (92.5%), and the median age was 40.82.6% were of the Catholic faith and 27.4% reported frequent alcohol consumption.More than half of the military personnel had 19 months or more working on the front line before COVID-19 (55.6%).Nine percent reported seeking mental health help during the COVID-19 pandemic.It was reported anxiety (20.3%), depression (6.5%), and posttraumatic stress disorder (6.5%).Most reported ITV in their children against COVID-19 (93%) (Table 1).

Mental Health and Other Factors Associated with COVID-19 Vaccination Intention toward Children of Military
Parents in Bivariate Analysis.In Table 2, the factors linked with ITV were marital status (p � 0.001), Catholic faith (p � 0.002), personal history of mental health (p � 0.016), military work time (p � 0.010), and suicidal risk (p � 0.039).[39].Likewise, a study conducted in Brazil estimated a reluctance to vaccinate against COVID-19 of 2.8%, even in parents who were reluctant to use other vaccines [67].However, a study conducted in Japan reported that only 64.7% of parents would vaccinate their children [68], and other studies conducted in the USA, Switzerland, and Latin America reported 67% [69], 59.2% [70], and 69.2% acceptance [71], respectively.In addition, our study found lower vaccination intention rates than those observed in other regions.In Korea, parents' average vaccination intention score for their children was 2.96 out of 7 points.In Egypt, 40.1% of parents expressed an intention to vaccinate their children against COVID-19 if available.In Oman, 56% of mothers with children aged 5 to 11 reported a likelihood or substantial likelihood of accepting vaccination.In Israel, 57% of parents with children aged 5 to 11 expressed an intention to vaccinate their children against COVID-19.However, these data are not comparable to this Peruvian study as, at the time of their execution, vaccines for minor children were not a real possibility, and clinical trials had not yet been completed in their entirety, generating greater distrust in the safety and efcacy of the vaccines.
Te high intention to vaccinate is explained by an increased concern for the well-being of children, who have been negatively afected in their growth, development, and mental health, secondary to school closures, family deaths, and higher rates of domestic violence during COVID-19 confnement [72,73].Similarly, job loss, decreased income, and fear of COVID-19 infection contributed to parental stress, and parents perceived the vaccine as a mitigation strategy for this complex disease [74].

Mental Health and Other Factors Associated with COVID-19 Vaccination Intention toward Children of Military
Parents.Seeking mental health support during the state of emergency due to COVID-19 increases the prevalence of vaccination intention in children by 8%, which is similar to the outcome from Murphy et al. when analyzing an Irish study, where they found that those who doubted the vaccine were less likely to have received treatment for a mental health problem (odds ratio � 0.63), compared to those who accepted it [75].Likewise, a study conducted in Latin America reported that those participants who had symptoms of anxiety (PR � 0.87) and depressive symptoms (PR � 0.93) were associated with higher parental intention to vaccinate their children and adolescents against COVID-19 [39].Tis fnding could be justifed because parents with such clinical conditions value the usefulness of vaccinations to a greater extent, as they are a vulnerable group to this disease [76].However, Nguyen et al. found that concerns about vaccination and lack of trust in the government, doubt about side efects, and efcacy of vaccines were higher among parents with any symptoms of anxiety or depression compared with those without symptoms.In addition, they reported that participants with mental health disorders had more signifcant barriers to accessing a vaccine, especially women [77], which could be explained by the fact that they spend more time caring for children and the more remarkable inability to take time of work to get vaccinated.One potential explanation for this association is the heightened awareness and health consciousness often accompanying individuals seeking mental health support.Military parents experiencing mental health challenges during the pandemic may develop a heightened sensitivity to health-related concerns, recognizing their vulnerability to severe outcomes from COVID-19.Tis increased awareness could lead to a proactive approach to healthpromoting behaviors, including a more positive attitude toward vaccination for their children.From a psychosocial perspective, engaging with mental health support services may empower parents to prioritize holistic health for their families.Seeking mental health support could serve as a catalyst for adopting preventive health measures and viewing vaccination as a crucial component of safeguarding their children's well-being.Te act of seeking help itself may contribute to a sense of responsibility and commitment to protective health behaviors, infuencing the decision-making process regarding vaccination.Having burnout syndrome was positively associated with a higher prevalence of intention to vaccinate in children in the crude model; however, no signifcant diferences were found in the adjusted model.Preexisting burnout could explain this fnding in burnout syndrome exacerbates the sense of danger and symptoms of distress about the likelihood of becoming ill or dying from COVID-19 [78].Tus, the fear that their children will have adverse outcomes from infection translates into an increased intention to vaccinate.Tere are no studies directly assessing burnout syndrome and vaccination intention, but Yigit et al. [74] presented a similar fnding, reporting that parents with high anxiety levels regarding COVID-19 infection had higher vaccine acceptability for themselves and their children.However, these fndings difer from those of Temsah et al. [79], where those parents with higher anxiety levels about possible adverse side efects of the vaccine were less likely to vaccinate their children.
Having a family member with mental health problems was positively associated with a higher prevalence of vaccination intention in children in the crude model; however, no signifcant diferences were found in the adjusted model.However, Milan et al. found that families whose mothers had a previous diagnosis of PTSD had signifcantly lower confdence in the COVID-19 vaccine and less intention to vaccinate themselves or their children.Tese fndings were explained by greater institutional distrust, less scientifc belief, and less interest in basing their vaccine decisions on government and healthcare sources [80].Te positive association between having a family member with mental health problems and a higher prevalence of vaccination intention in children in the crude model may be explained by an increased awareness of health risks and a heightened sense of vulnerability in these families.Individuals experiencing mental health issues or having close family members with such problems might be more attuned to health-related threats, including the risks posed by infectious diseases such as COVID-19.Tis heightened awareness could lead to a greater willingness to vaccinate children as a preventive measure.Additionally, the shared experience of dealing with mental health challenges within the family might foster a collective approach to health protection, infuencing vaccination decisions.
It was found that having the Catholic faith increased the prevalence of ITV in children by 23%, which is similar to that reported by Corcoran et al., where it was observed that nonevangelical Protestants, Catholics, Jews, and atheists were more likely to have received a COVID-19 vaccine compared to evangelical Protestants (OR 2.02) [81].Te Catholic Church has supported the vaccination program of diferent governments and has allowed their Church facilities to be community vaccination centers [82].However, Williams et al. found no statistical signifcance between parental reluctance to vaccinations and adherence to major religious traditions in a group of 250 Latino Christian caregivers in the USA [83].Our fnding difers from that reported in South Korea, where 298 parents of children aged 5 to 11 participated, and religion did not emerge as a signifcantly associated factor with vaccination intention.It also difers from a multicentric study conducted in 90 countries, which found that Christianity was associated with a lower rate of COVID-19 vaccination.Tese fndings show that faith-based religious resistance to vaccination is rare and that if it exists, it is mediated by distrust of science and political afliations rather than theology [84].One potential mechanism underlying this association could be the strong infuence of religious beliefs on health-related decisionmaking within the Catholic community.Catholic teachings often emphasize the value of life and the importance of safeguarding the well-being of individuals, aligning with the broader public health goals of vaccination.Te moral and ethical dimensions associated with the Catholic faith might amplify the perceived importance of protecting children from the severe consequences of COVID-19, thus fostering a higher intention to vaccinate.Additionally, the sense of community and shared values within religious groups can play a role in shaping health behaviors.In the context of vaccination, the Catholic faith community may provide a supportive environment where vaccine-related information is disseminated and positive attitudes toward vaccination are reinforced.Social norms within religious communities can infuence individual attitudes, potentially contributing to the observed increased prevalence of COVID-19 vaccination intention in children among military parents of the Catholic faith.

Implication of Findings in Public Health and Mental
Health.Te high prevalence of intention to vaccinate observed in this demographic, notably 9 out of 10 military personnel expressing their commitment to vaccinating their minor children against COVID-19, underscores the importance of targeted vaccination campaigns within military communities.Understanding the driving forces behind this intention, such as a heightened concern for children's wellbeing amidst the challenges posed by the pandemic, underscores the need for tailored public health messaging.As the military plays a crucial role in national defense, ensuring the health and resilience of military families through effective vaccination initiatives safeguards individual wellbeing and contributes to broader national health security.
Te salient fndings revealing the signifcant associations between mental health factors (such as previously sought mental health assistance, burnout, and mental health history in the family), Catholic faith, and vaccination intention among military parents carry profound implications for public health strategies within the military context.Addressing mental health concerns is pivotal, as the positive association between vaccination intention and seeking mental health assistance highlights the interconnectedness of mental well-being and preventive health behaviors.Implementing targeted mental health support programs tailored to the unique challenges faced by military parents can foster a healthier community and positively infuence vaccination decision-making.Te impact of religious beliefs, mainly Catholic faith, on vaccination intention, underscores the importance of respecting and accommodating diverse religious perspectives within the military population.

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Crafting vaccine communication strategies that align with religious values can enhance vaccine acceptance and contribute to building trust in the military healthcare system.Furthermore, recognizing the infuence of burnout and a family history of mental health issues emphasizes the need for holistic support mechanisms.Implementing interventions to alleviate burnout and providing resources for families with mental health histories can contribute to the overall resilience and well-being of military families.

4.4.
Limitations.Tis research has some limitations.Firstly, its methodology does not allow the ability to attribute causality between mental health and intention to vaccinate against COVID-19.Secondly, the potential selection bias because the prevalence of vaccination does not represent the prevalence of the general national population since the preliminary study included only one regional site in the Northern Region of Peru.Additionally, there could be an information bias since it was impossible to measure the educational level, political party afliation, economic security, food security [35], parental beliefs, fnancial constraints during the COVID period, the number of children, parental COVID-19 vaccination history, experience of side efects and postvaccination symptoms in parents, parental history of COVID, the extent to which parents perceived pressure from their surroundings to vaccinate their children against COVID-19, perceived behavioral control over COVID-19 vaccination, and attitudes toward COVID-19 vaccination, which have been shown to infuence vaccination intention.Despite these limitations, the outcomes have relevant implications for public and mental health professionals in designing psychological interventions in the military population, which is exposed to high workloads and stress exacerbated by the pandemic.Likewise, this is the frst study that evaluates the association between mental health and vaccination intention in the Peruvian military for their children.Te specifc data collection from only one city can limit the generalization of the outcomes.Also, the lack of control of confounding variables could infuence vaccination intentions; therefore, this is a limitation that is recognized in the current study.Due to this, participants may have overreported their vaccination intentions or underreported mental health concerns.

Recommendations.
Te results of this study highlight the usefulness of implementing strategies focused on populations vulnerable to worse outcomes by COVID-19, such as patients with mental health disorders [85].Considering the increase in the number of people living with mental health disorders after the pandemic, coupled with the neglect and stigma that still prevail in Peruvian society, there is an imminent need to address mental health in the population through more specialized primary health care [86].Vaccination against COVID-19 is positively related to improving mental health in the population; therefore, health professionals and government authorities should work together to pay signifcantly greater attention to this group of patients and ensure their ultimate immunization.
Recommendations for future research include carrying out longitudinal studies to better understand the causality between mental health factors and vaccination intentions.Future research could adopt a longitudinal design.Terefore, broader sampling strategies are needed to expand the study to include a wider range of military personnel across diferent regions, which could enhance the generalizability of the fndings.Also, it is relevant to conduct qualitative insights, as incorporating qualitative methods could provide deeper insights into the personal experiences and beliefs that underlie vaccination intentions.

Conclusions
Finding mental health support, experiencing burnout syndrome, having a relative who sufers from mental health problems, and being part of the Catholic religion were associated with a higher willingness to immunize the children of Peruvian military members.Te study opens avenues for further research to explore the complex interplay between mental health, religious beliefs, and vaccination intentions in diferent populations and settings.
Body mass index and working time were continuous numerical variables.Physical health variables included alcohol and tobacco use, history of hypertension, and diabetes; they were analyzed as dichotomous.Mental health variables were seeking mental health support and a history of personal or family mental health disorders.Likewise, food insecurity and trust in government were dichotomous categorical variables.Univariate analysis of the variables was performed, obtaining means and standard deviations for quantitative variables with normal distribution; median and interquartile ranges were reported, and frequencies and proportions for qualitative variables were reported.
[61]59][58,59].Cutof points: EB > 26, and DP > 9, PF < 34, where EB � emotional burnout, PF � personal fulfllment, and DP � depersonalization[59].(e)Posttraumaticstressdisorder(PTSD) checklist (PCL-C): Consisting of 17 questions, it explores the re-experiencing of the trauma, trauma avoidance blunting, and hyperarousal symptoms and defnes PTSD as a score of 43 or more[60].It has been validated in the Chilean population after the 2010 earthquake in Chile[61]and used to evaluate PTSD in Peruvians after the 2007 earthquake in Pisco, entered to ensure data quality.Te dependent variable of intention to vaccinate children was evaluated with the following question: "Would you vaccinate your child against COVID-19?Stata v.17.0 was then used for statistical analysis."We analyzed the intention to vaccinate as a binomial outcome.Sociodemographic polytomous categorical variables included age, sex, marital status, educational level, and religion; childbearing was dichotomous.

Table 3 :
Factors linked with IFV in simple and multiple regression analysis.